Physicians as Complex Adaptive Systems

The life of every physician is a complex system. The physician's challenge is to make it a complex adaptive, as opposed to a maladaptive, system.

Here are some of the attributes of a complex adaptive system:

• It is complex.

The number of parts (and types of parts) and the number of links between the
parts is non-trivial, e.g., the system is complex.

The relationship between the system and its environment are non-trivial.

• It is adaptive.

The system includes feedback.

The system can adapt itself according to feedback.

• It does not exist in a vacuum.

The relationship between the system and its environment is non-trivial or non-linear.

The system can be influenced by and can adapt itself to its environment.

Complexity

The first step to coping effectively with complexity is to acknowledge it.

A physician's life has two dimensions. The first dimension is the set of different roles, parts and functions: healthcare provider, scientist, businessperson, spouse, parent, etc. The second dimension includes the content and elements of each role.

Both the roles and their elements are complex. When combined, the complexity increases geometrically. That is, the responsibilities of a healthcare provider are complex, as are the responsibilities of a spouse. And the complexity of being both a successful healthcare provider and a successful spouse is more than the sum of the parts; it is some multiple and the multiplier gets bigger with each added role.

Anyone who says, "How hard can it be?" does not understand the situation.

Adaptive capacity

The system that is a physician's life gets plenty of feedback. The problem is that a variety of pressures prevent the physician from analyzing and then responding effectively to the feedback.

Effective adaptability requires reflection: What happened? What is good or bad about it? What needs to change to produce the result I want? What resources are available? It also requires a commitment to action.

Analysis and action are the key differentiators between an adaptive system with a positive trajectory and a maladaptive system with a deteriorating status quo. To be clear, I am not saying, "How hard can it be?" because I know it can be hard. The results are worth the effort.

Environmental awareness

The distinction between environmental awareness and feedback can be subtle. The goal is to be aware enough of environmental changes that you can respond to them before they have produced feedback.

Environmental awareness can keep you ahead of the curve, developing momentum and exploiting opportunities. By the time there is positive feedback related to an environmental change, some amount of opportunity has been lost. Negative feedback means energy that could have been spent moving forward must be diverted to digging out of a hole.

As to the necessity for the system to be able to adapt to the environment, just remember we no longer see live dinosaurs, even in the zoo. It is not necessary to like the changes, but survival mandates acknowledging and accommodating them.

It is not news that physician's lives are complex. The advantages of being an adaptive system are obvious. While it is all very interesting, nothing here speaks directly to how a physician would go about structuring her life as a complex adaptive system. We'll get to that next week.